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Date run 2/23/2007 12:21:39PI SAN J0 d )UIN COUNTY ENVIRONMENTAL HE'�—14 DEPARTMENT <br /> Run by - Report#5021 <br /> .. Facility Information as of 2/23PtulT! Pagel <br /> Retard Selection Criteria: Facility ID FA0005839 �-1 <br /> RECEIVE Yakhanges/corrections in RED ink or penclL <br /> INFORMATION CHANGE(date) <br /> AN JUHUUIN <br /> ""_�� N 2007 I;UUN I Y OWNERSHIP CHANGE(date) �ZZ <br /> p 7 <br /> OWNER FILE INFORMATION <br /> Owner ID OW0004647 OFFICE OF EMERGENOYNSERVICES <br /> ew,Owner ID <br /> Owner Name LOMBANA, LUIS �� <br /> Owner DBA CASTLE AUTOMOTIVE <br /> Owner Address 2315 N EL DORADO <br /> STOCKTON, CA 95204 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-943-0196 <br /> Mailing Address 2315 N ELDORADO ST - <br /> Care of STOCKTON, CA 95204 , E <br /> FACILITY FILE INFORMATION Site Mitigation Facility <br /> Facility ID FA0005839 <br /> Facility Name CASTLE AUTOMOTIVE <br /> Location 2315 N EL DORADO ST <br /> STOCKTON, CA 95204 <br /> Phone 209-942-3693 <br /> Mailing Address 2315 N EL DORADO ST <br /> STOCKTON, CA 95204 <br /> Care of <br /> Location Code 01 -STOCKTON APN: <br /> BOS District 001 - GUTIERREZ, STEVE SIC Code:9900 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> AccountlD AR0006651 New Account ID. <br /> Mail Invoices to Owner Mail Invoices to: Owner / Facility / Account <br /> Account Name LOMBANA, LUIS (Circle One) <br /> Account Balance as of 2/23/2007: $124.00 <br /> Transler to (Circle One) <br /> ActiveAnactve <br /> Program/Element and Description Record 10 Employee ID and Name status New Owner? Delete <br /> 2244-PACT TRANSFER RECORD-OES PRO521172 EE000o000-HAZ MAT SJC DES Active Y N A I D <br /> 2381 -UST FACILITY(BEFORE 1/84)-obsolete PRO503416 EE0000451 -STEVE SASSON Inactive Y N A 1 D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHARIPRO519142 EE0000451 -STEVE SASSON Inactive Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,pHs/EHD hourly charges associated with this <br /> facility or activity will be billed to the party Identified!as the OWNER on this form. I also certfy that all operations will be performed in accordance with all applicable Ondna Codes and/or standards and <br /> State and/or Federal Laws. T <br /> APPLICANTS SIGNATURE: Date 0I.�,2 <br /> Program Records to be TRANSFERED: _*$20,00=__ Amount Paid Date <br /> Water System to be T ISFERED: $372.00= Amount Paid Date / / <br /> Paym tTy e " C e Number Received by <br /> REH Date Z'/ �' 7 Account out: Date <br /> COM <br /> IRIECIMWED <br /> FEB 2 3 2007 <br /> ENVIRONMENT HEALTH <br /> \\phs-ehsgl-nt\epps\envisions\reports\5021.rpt PERMIT/SERVICES <br />